Haemophilus influenzae type b (Hib): The vaccine is recommended for certain adults at increased risk for Hib who have not received the vaccine before, except for those with HIV because their risk for Hib infection is low. Adults who have had a successful hematopoietic stem cell transplant are recommended to receive a 3–dose series of Hib vaccine 6 to 12 months after the transplant regardless of Hib vaccination status.

Influenza vaccine: The update adds information on the use of the recombinant influenza (RIV) and inactivated influenza (IIV) vaccines among egg–allergic patients was added to the footnote and indicates that RIV or IIV can be used among persons with hives–only allergy to eggs, as it contains no egg protein.

Td/Tdap: The tetanus, diphtheria, acellular pertussis (Tdap) and tetanus, diphtheria (Td) vaccines footnote was edited to harmonize with the language used in the pediatric immunization schedule. A single dose of Tdap vaccine is recommended for previously unvaccinated persons aged 11 years or older, and Td booster should be administered every 10 years thereafter."

Human papillomavirus: "Information was added to the human papillomavirus…vaccine footnote to clarify the timing between the second and third doses and to harmonize language between the pediatric and adult immunization schedules. No changes in recommendations were made."

Zoster: Being a healthcare worker is no longer an indication for vaccination.

Pneumococcal vaccines: PCV13 (the 13–valent pneumococcal vaccine) is recommended to be administered before PPSV23 (the 23–valent pneumococcal vaccine) among persons for whom both vaccines are recommended.

Meningococcal vaccine: The footnote "was edited to clarify which persons need either 1 or 2 doses of vaccine and to provide greater clarity regarding which patients should receive meningococcal conjugate (MenACWY–D) versus the meningococcal polysaccharide (MenACWY–CRM)."

The cave of Amarnath was chosen by Lord Shiva to narrate the secrets of meditation, immortality and creation of Universe to Parvati.

A spiritual journey requires a spiritual frame of mind and a commitment of 7–10 days for self purification. Most spiritual destinations are located at up into mountains to provide a pollution free environment and involve a difficult travel so that nobody can reach the destination before 7–10 days.

This duration helps in controlling the mind, intellect, ego and getting rid of the desires, attachments and greed.

On the path of spiritual journey as one is travelling alone without carrying the worldly attachments, one invariably reaches the destination in a positive state of mind and in a meditative phase to experience the truth of life and answers to unanswered questions.

A Bowl of Noodles from a Stranger

That night, Sue quarreled with her mother, and then stormed out of the house. While enroute, she remembered that she did not have any money in her pocket, she did not even have enough coins to make a phone call home.

At the same time, she went through a noodle shop, picking up sweet fragrance, she suddenly felt very hungry. She wished for a bowl of noodles, but she had no money! The seller saw her standing wheat faltered before the counter and asked:

– Hey little girl, you want to eat a bowl? But … but I do not carry money … she shyly replied. Okay, I’ll treat you, the seller said – come in; I will cook you a bowl.

A few minutes later the owner brought her a steaming bowl of noodles. Ate some pieces, Sue cried. What is it? He asked. Nothing. I am just touched by your kindness! Sue said as she wiped her tears. Even a stranger on the street gives me a bowl of noodles, and my mother, after a quarrel, chased me out of the house. She is cruel!! The seller sighed: Girl, why did you think so? Think again. I only gave you a bowl of noodles and you felt that way. Your mother had raised you since you were little, why were you not grateful and disobeyed your mom? Sue was really surprised after hearing that.

"Why did I not think of that? A bowl of noodles from a stranger made me feel indebted, and my mother has raised me since I was little and I have never felt so, even a little.… On the way home, Sue thought in her head what she would say to her mother when she arrives home: "Mom, I’m sorry. I know it is my fault, please forgive me…" Once up the steps, Sue saw her mother worried and tired of looking for her everywhere. Upon seeing Sue, her mother gently said: "Sue, come inside honey. You are probably very hungry? I cooked rice and prepared the meal already, come eat while it is still hot …"

Cannot control any longer, Sue cried in her mom’s hands. In life, we sometimes easy to appreciate the small actions of some people around us, but for the relatives, especially parents, we see their sacrifices as a matter of natural … Parental love and concern are the most precious gifts we have been given since birth.

Parents do not expect us to pay back for nurturing us …… but have we ever appreciated or treasure the unconditional sacrifice of our parents?

News Around The Globe

A novel study published online in Annals of Family Medicine reported that less than one–third of physicians trained to prescribe buprenorphine for opioid–addicted patients actually prescribe it. The situation is quite disappointing since the problem of opioid addiction has grown remarkably in the US.

Hydrocodone/acetaminophen (Vicodin, AbbVie) is not better than codeine/acetaminophen (Tylenol #3, McNeil) in acute pain relief, reports a new study presented at the American Academy of Pain Medicine (AAPM) 30th Annual Meeting. Patients were contacted about 26 hours after discharge to ask for their pain rating score just before and 2 hours following last dose. The mean decrease in the pain scores 2 hours after pain medications was 3.9 in the hydrocodone/acetaminophen group and 3.5 in the codeine/acetaminophen group.

A new review of past studies reported that individuals who quit smoking have improved mood. The review authors noted during their research that smoking cessation had effects similar to antidepressant treatment on mental health.

A study published online March 10 in the Journal of Clinical Oncology revealed that stereotactic body radiotherapy (SBRT), though less expensive and faster for patients with prostate cancer, is more toxic than intensity–modulated radiation therapy (IMRT). The study included 1335 patients treated with SBRT and 2670 matched patients treated with IMRT. At 6 months, more SBRT patients had a Medicare claim for treatment–related GU toxicity (15.6% vs. 12.6%) as compared to IMRT patients. This study raises some caution that there may be more urinary side effects with the treatment.

A pooled analysis of 11 cohort studies has suggested that a larger waist circumference, irrespective of body–mass index (BMI), is closely associated with an increased risk of mortality. BMI and waist circumference are both significant predictors of mortality and should therefore be considered in combination to help categorize patients at risk for obesity–related mortality. The report was published March 13 in the Mayo Clinic Proceedings.

This is the age of smartphones. To improve usability and readability, eMedinewS has launched a mobile app of the newsletter for its readers. You can now also view eMedinewS on your smart phones or iPads.

The various icons for downloading are provided on the top of the newsletter. Choose the icon that is compatible with your device, whether iPhone, Android, Blackberry, iPad, Desktop/Windows phone or GSM
Click on the icon ‘e’ from the mail and download to install the app to the home screen of your mobile phone, iPad or Desktop. After you finish downloading, you will see an icon ‘e’ on the home screen of your device. That’s it.

Now you don’t need to type the address of the website in your web browser or log in to your email account every day to read the newsletter. Just click on the app and begin reading.

Rabies News (Dr. A K Gupta)

Are there any dietary restrictions during intradermal rabies vaccination (IDRV)?

There are no dietary restrictions during IDRV. However, alcohol may be avoided as it may affect the immune response.

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

University of Chicago’s Department of Psychology has come up with a very interesting finding. The study says that children who use their hands to gesture during a math lesson attain a deeper understanding of the problems they are taught. Abstract gesture thus appears to be a more effective teaching tool than concrete action.

A study published recently in the journal Infection and Immunity reported that early childhood caries could be due to an interaction between a bacterium and a fungus. The researchers showed that infection by Streptococcus mutans and Candida albicans together could increase the number of cavities two–fold and heightened their severity several–fold. The resulting tooth decay can be so severe that treatment frequently requires surgery – in the operating room.

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

Only a minority of adverse effects reported during statin therapy can be attributed to the drug directly, reports a novel study published online March 13 in the European Journal of Preventive Cardiology. Researchers evaluated 14 primary–prevention studies and 15 secondary–prevention studies. In primary prevention, statin therapy raised the absolute risk of diabetes by 0.5% and decreased the risk of mortality by 0.5%. In secondary prevention, statin therapy decreased the risk of death by 1.4%. Additionally, in both primary and secondary prevention, statin therapy led an asymptomatic, 0.4% absolute increase in liver enzymes. Of note, majority of side effects in primary– and secondary–prevention patients were common in the placebo and the statin arm.

Researchers at the Sanford-Burnham Medical Research Institute (Sanford–Burnham), the Cardiovascular Research Center at Icahn School of Medicine at Mount Sinai, and the University of California, San Diego have uncovered the microRNA miR–25 that blocks a gene SERCA2a which regulates the flow of calcium across heart–muscle cells. Researchers have noted that miR–25 delays proper calcium uptake in heart–muscle cells, leading an individual to heart failure.

Hepatitis A, E and Typhoid are the hygiene markers of a city

It is diseases such as jaundice with hepatitis A in children and E in adults, typhoid, cholera and gastroenteritis that reflect the hygiene status of a city and not the occurrence of dengue and malaria.

Food and water–borne diseases can be eradicated by the following public awareness formula: When in doubt follow the principle, "heat it, boil it, cook it, peel it or forget it". This means that in an unhygienic environment, one can eat an orange or a banana but not tomato or apple. Other steps are:

Do not eat salad that has been left open for more than 2 hours even if it is washed properly.

Do not eat cooked food that has been left on the table for more than two hours.

Vegetables grown under the ground or over the surface of the ground should be washed properly before eating them raw. They may be the biggest source of worm infection in the brain, a condition called neurocysticercosis.

Boiled water is the safest water to drink.

Ice made from unhygienic water can be the source of most water–borne diseases.

It is our duty to keep our home and city as clean as possible. We must regard our city as our extended home, a garden as our farmhouse and roads as are our personal walking tracks.

Most food and water–borne diseases are self–inflicted and can be managed by a simple step of washing the hands before and after using the toilet and before and after consuming any food.

If you have depression, a thorough physical exam and careful medical history should be evaluated to pinpoint a physical source of the problem for an appropriate treatment, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

In patients with depression, one must not only look for what’s going on in the mind and brain but also check for what’s going on in the body. Many medical problems are linked to mood disturbances.

Over fifty percent of heart attack survivors and those with cancer report feeling depressed. Depression is also linked to diabetes, Parkinson’s and other chronic conditions.

Depression too can affect the course of a physical disease. Depression is linked with slower recovery from a heart attack and an increased risk for future heart trouble.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 88792 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

A 64–year–old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively, her end–tidal carbon–dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

Yesterday’s Mind Teaser: At the end of a balanced anaesthesia technique with non–depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

An Israeli soldier who just enlisted asked the Commanding Officer for a 3–day pass.

The CO says "Are you crazy? You just join the Israeli army, and you already want a 3–day pass? You must do something spectacular for that recognition!"

So the soldier comes back a day later in an Arab tank!

The CO was so impressed, he asked "How did you do it?"

"Well, I jumped in a tank, and went toward the border with the Arabs. I approached the border, and saw an Arab tank. I put my white flag up, the Arab tank put his white flag up. I said to the Arab soldier, "Do you want to get a three–day pass? So we exchanged tanks!"

Click on the image to enlarge

Situation: A patient with dengue died.Reaction: Oh my God, why was he not given adequate fluids?Lesson: Make Sure that all patients with dengue are given fluids to correct intravascular dehydration.

Dr KK Aggarwal: Failing doesn’t make you a failure. Giving up, accepting your failure, refusing to try again does! Richard Exely http://bit.ly/15QdVeB #HealthDr Deepak Chopra: We are the eternal possibility, the immeasurable potential of all that was, is, and will be.